Provider Demographics
NPI:1871562041
Name:SPINGARN, ROGER W (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:W
Last Name:SPINGARN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1400 CENTRE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2454
Mailing Address - Country:US
Mailing Address - Phone:617-244-9929
Mailing Address - Fax:617-244-9935
Practice Address - Street 1:1400 CENTRE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-2454
Practice Address - Country:US
Practice Address - Phone:617-244-9929
Practice Address - Fax:617-244-9935
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-12-05
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Provider Licenses
StateLicense IDTaxonomies
MA775732080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3142442Medicaid
MA3142442Medicaid